Bovard Jacqueline, Frysch Tammie, Tong Nora, Sharma Sonali, Yong-Hing Charlotte J
Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Can Assoc Radiol J. 2025 Aug;76(3):489-496. doi: 10.1177/08465371241306737. Epub 2024 Dec 21.
Breast Imaging-Reporting and Data System (BI-RADS) density scores have been included in screening mammography reports in BC since 2018. Despite these density scores being present in screening mammography reports for numerous years, there remains insufficient evidence to guide supplemental testing for patients with dense breasts. The primary objective of this study was to evaluate how primary care providers in Canada utilize BI-RADS density scores reported on normal screening mammograms of average risk, asymptomatic patients in their clinical practice. The secondary objective of this study was to determine if there are any patterns related to primary care provider demographics and practice settings in BC that could be linked to differences in screening practices for patients based on BI-RADS density scores. A cross-sectional survey was conducted with family physicians (FPs) and nurse practitioners (NPs) practicing in BC. Descriptive statistics were calculated using percentages and further stratified by participant demographics. values were derived from Fisher's exact test and results were regarded as statistically significant at < .05. Ninety-eight participants (85 FPs, 13 NPs) responded to the survey. The percentage of participants who ordered supplemental testing based on BI-RADS density scores alone was 8% for BI-RADS score D, 37% for BI-RADS scores C or D, and 2% for BI-RADS scores B, C, or D. Forty-eight percent of female participants and 45% of male participants would order supplemental testing based on BI-RADS density scores alone ( = 1). Forty-nine percent of FPs and 39% of NPs would order supplemental testing based on BI-RADS density scores ( = .56). Fifty-three percent of participants who had been in practice for more than 10 years, 50% of those who had been in practice for 6 to 10 years, and 36% of those in practice for 5 years or less would order supplemental testing ( = .34). Fifty-seven percent of those practicing in large urban centres, 43% of those practicing in medium-sized communities, and 32% of those in rural or remote communities would order testing ( = .17). Fifty-seven percent of participants were aware of the increased risk of breast cancer with higher breast density. Variations exist in how primary care providers in BC utilize the BI-RADS density scores reported on normal screening mammography of average risk, asymptomatic patients in their clinical practice. Further research in this area is needed to establish clearer clinical guidelines to educate and inform primary care providers on the need for supplemental testing for patients with dense breasts and to improve resources for breast cancer screening in BC.
自2018年以来，乳腺影像报告和数据系统（BI-RADS）密度评分已被纳入不列颠哥伦比亚省（BC）的乳腺钼靶筛查报告中。尽管这些密度评分已存在于筛查乳腺钼靶报告中多年，但仍缺乏足够证据来指导对乳腺致密患者的补充检查。本研究的主要目的是评估加拿大的初级保健提供者在其临床实践中如何利用平均风险、无症状患者的正常筛查乳腺钼靶报告中所报告的BI-RADS密度评分。本研究的次要目的是确定BC省是否存在与初级保健提供者的人口统计学特征和执业环境相关的模式，这些模式可能与基于BI-RADS密度评分的患者筛查实践差异有关。对在BC省执业的家庭医生（FPs）和执业护士（NPs）进行了一项横断面调查。使用百分比计算描述性统计数据，并根据参与者的人口统计学特征进一步分层。P值来自Fisher精确检验，结果在P<0.05时被视为具有统计学意义。98名参与者（85名FPs，13名NPs）回复了调查。仅基于BI-RADS密度评分进行补充检查的参与者百分比，BI-RADS D级为8%，BI-RADS C级或D级为37%，BI-RADS B级、C级或D级为2%。48%的女性参与者和45%的男性参与者会仅基于BI-RADS密度评分进行补充检查（P = 1）。49%的FPs和39%的NPs会基于BI-RADS密度评分进行补充检查（P = 0.56）。执业超过10年的参与者中有53%、执业6至10年的参与者中有50%、执业5年或以下的参与者中有36%会进行补充检查（P = 0.34）。在大城市中心执业的参与者中有57%、在中型社区执业的参与者中有43%、在农村或偏远社区执业的参与者中有32%会进行检查（P = 0.17）。57%的参与者知晓乳腺密度越高患乳腺癌的风险越高。BC省的初级保健提供者在其临床实践中利用平均风险、无症状患者的正常筛查乳腺钼靶报告中所报告的BI-RADS密度评分的方式存在差异。需要在该领域进行进一步研究，以建立更清晰的临床指南，教育并告知初级保健提供者对乳腺致密患者进行补充检查的必要性，并改善BC省的乳腺癌筛查资源。
